Provider Demographics
NPI:1134157555
Name:AGUILA, PHILLIP BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BERNARD
Last Name:AGUILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:2000 FOUNDATION WAY STE 3300
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9198
Practice Address - Country:US
Practice Address - Phone:304-596-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23941207R00000X, 207RC0200X, 207RP1001X
NC200100115207RP1001X
FLME0089936207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA428008181AOtherMEDICAID OF GEORGIA
FL7936250OtherAETNA
WV3810017786Medicaid
WVP00966065OtherRAILROAD MEDICARE
WVWV2369B987OtherPTAN
FL272072800Medicaid
FL48037YOtherBCBS OF FLORIDA
FL48037YOtherBCBS OF FLORIDA
WVP00966065OtherRAILROAD MEDICARE
WV3810017786Medicaid
FLP00184422Medicare PIN